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A  FOR EH&S USE ONLY DATE SUBMITTED GRANT PPENDIX E DIVE PLAN FORM

APPENDIX E

Florida Atlantic University

Diving Safety Program





DIVE PLAN SUBMITTAL FORM DSO Signature


Proposed Expedition Dates:____________________ through


General Dive Site Location:


Dive Plan Submitted By:


Principal Investigator:_______________________ Lead Diver:


Is this Dive Plan in Support of a Grant: ____________ Grant No.:


Proposed No. of Dives: ____________ Proposed No. of Divers:

(Profile each dive if different) (List each diver on info. Sheet)


Will this Plan Involve:

General Dive Plan Considerations


An Emergency Plan MUST be completed for each expedition including the following: emergency contact information (including name, relation and telephone number) for each diver, nearest recompression chamber, nearest accessible hospital and anticipated means of transportation.


DIVE PLAN

Diving Roster

Name Level Depth Certification


1. _____ Lead Diver-Scientific Diver fsw


2. fsw


3. fsw


4. fsw

5. fsw


6. fsw


7. fsw

8. fsw


9. fsw


10. fsw


Any Non-FAU Personnel:

(include parent organization or auspices)


Purpose of Dives:



Operational Plan


Maximum Depth: ____________ ft Number of dives/diver/day:


Dive Tables and/or dive computers to be used:


Decompression schedules and repetitive dive plans:

(use dive profile worksheet for detailed plan)


Diving work plans:

(attach detailed explanation if necessary)


Specialty dives if planned:

(see DBSM Section 11.00)


Nitrox, or mixed gases:

(include percentages)


Tools or Specialized Equipment Used:

(diving sleds, scooters, drills, surface supply, hookah, tethers, etc.)



Dive Site


Name of Boat or Vessel: Reg. #:


Beach or Other Site:


Safety Considerations


Any Hazardous Conditions Anticipated:

(ie: Cold water, night diving, extreme currents, extreme depths)



Safety Precautions: (ie: Chase vessel, dry suits)

Resuscitator

International Travel


Contacts in country:

(include name and phone number)


U. S. Consulate or Embassy:

(include phone, fax, address)


For International Travel: Attach a copy of all itineraries including flight times and accommodations with contact information which will be utilized.


DIVE PROFILE WORKSHEET

Date: Location: Dive No.:

Note: Use one sheet per dive profile.

Weather:

Seas:

Current:

Visibility:

Temperature:

Substrate:


Lead Diver : _


Buddy Team 1: &

Buddy Team 2: &

Buddy Team 3: &

Buddy Team 4: &

Buddy Team 5: &

SI= RG RG .

| | Safety stop min

Depth _ | |

No-D _______ | |

Gas used: Limit | | Time in:

RNT= Time out:

____________________________ Water Temp _______

TBT/EBT=















Multi-level


TBT/EBT = BT + RESIDUAL NITROGEN TIME

= BT X RF (DCIEM)


Multi-level EBT = BT + RAT


If any Multi-level TBT/EBT equals the No-D limits, a 5 minute safety stop at 10 feet is required.

DEPTH FT




NO-D LIMIT MIN.




BOTTOM TIME MIN.




EFFECTIVE B.T. MIN.




REPETIVE GROUP




DECOMPRESSION DEPTH

30 ft

20 ft

10 ft

DECOMPRESSION TIME





Safety Dive Profile Planning


Use this table to plan contingency depths and times in the event planned depth or planned time profiles are exceeded.


PLANNED DEPTH (PD)


NO – D LIMIT

PT + 5MIN

NEW EBT

DECOMPRESSION TIME(S) 30’ 20’ 10’

PD + 10 ft.








PD + 20 ft.









* Multi-level dive planning-substitute 2nd and 3rd depth for PD+10 and PD+20, respectively.
















*** USE ADDITIONAL SHEETS AS NEEDED ***

LEAD DIVER CHECKSHEET

(complete prior to departing to dive site)


It is the responsibility of the Lead Diver to assure that each of the following items has been checked and that all divers have all required gear.


Administrative




Dive Support

All Divers Have:

Tube (Diver’s Sausage)


Comments:



______________________________ _____________________

Lead Diver Print Name Date


Signature



DIVING ACCIDENT EMERGENCY MANAGEMENT PLAN


A diving accident victim is any person who has been breathing air underwater regardless of depth. It is essential that emergency procedures are pre-planned and that medical treatment is initiated as soon as possible. It is the responsibility of the expedition’s Dive master to develop procedures for such emergencies including evacuation and medical treatment for each dive location.

General Procedures:

Depending on and according to the nature of the diving accident, stabilize the patient, administer 100% oxygen, and initiate the local Emergency Medical System (EMS) for transport to nearest medical facility. Explain the circumstances of the dive incident to the evacuation team, medics and physicians. Do NOT assume that they understand why 100% Oxygen may be required for the diving accident victim or that recompression treatment may be necessary. If time allows, complete some or of the CALL-IN DATA SHEET.


  1. Rescue victim and/or position so the proper procedures may be initiated.

  2. Establish (A)irway, (B)reathing and (C)irculation as required.

  3. Administer 100% oxygen, if appropriate (in cases of Decompression Illness or Near Drowning).

  4. Activate the local EMS for transport to the nearest appropriate medical facility. (the local EMS will vary from site to site – it must be stated in dive plan)

  5. Contact the Diver’s Alert Network as deemed necessary.

  6. Contact Diving Safety Officer (DSO) and Emergency Contact Person, as deemed necessary.

  7. Complete and submit Incident Report Form (in manual) to DSO.


Expedition Emergency Contact Numbers:

(Appendix 7)

Nearest Medical Treatment Facility to Dive Site:

(Appendix 7)

Nearest Recompression Facility to Dive Site:

(Appendix 7)


Diver’s Alert Network (DAN):

24 hour medical advise–if necessary call collect and state “I have a Medical Emergency”–Use to locate closest recompression chamber or physician consultations.



EMERGENCY CONTACT INFORMATION FOR EACH DIVER


Diver:

Emergency Contact: Relation:


Work Telephone: Home Telephone:


Street Address:


City: State: Zip:



Diver:

Emergency Contact: Relation:


Work Telephone: Home Telephone:


Street Address:


City: State: Zip:



Diver:

Emergency Contact: Relation:


Work Telephone: Home Telephone:


Street Address:


City: State: Zip:



Diver:

Emergency Contact: Relation:


Work Telephone: Home Telephone:


Street Address:


City: State: Zip:


*** USE ADDITIONAL SHEETS AS NEEDED ***





DIVE PLAN APPROVAL



I certify that this dive plan has been completed in compliance with the Florida Atlantic University Diving/ Boating Safety Subcommittee policies and procedures as well as 29 CFR 1910.401. I further certify that all information provided in this plan is true and correct to the best of my knowledge.


All dive plans should be returned to the Diving Safety Officer, or designee within one week following completion of the planned dives(s).




Principle Investigator: _____________________________________

(Print Name)

_____________________________________ ____________ (Signature) (Date)



Dive Team Leader: ______________________________________

(Print Name)


______________________________________ ____________

(Signature) (Date)


For EH&S Use Only



Dive Plan reviewed by:

(print name) (title)


Approved: Yes No Date:


______________________________________

(Signature)






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